Racial Bias and the Misdiagnosis of Mental Illness

Rebecca Leon, MHC-LP

In the realm of mental health diagnosis and treatment, a troubling reality often goes unaddressed: the pervasive influence of racial bias. While psychiatry and psychotherapy are dedicated to understanding and treating mental illness, the intersection of racial bias and misdiagnosis has become a concerning issue that demands our attention. In fact, the impact of racial bias within the mental health field can have deadly consequences, shedding light on the need for widespread awareness and systemic change. 

Racial Bias Within Mental Health Treatment

Racial bias, whether implicit or explicit, infiltrates various aspects of society, and the mental health field is no exception. Bias may occur in the beliefs and actions of individual clinicians. On a larger scale, bias may occur when baseless assumptions become normative beliefs shared by members of practitioner networks or treatment organizations. Bias may also occur when authorities and community members display intolerance toward marginalized individuals with mental illnesses and apply different standards when enforcing societal norms for acceptable behavior (Snowden, 2023). These biases can lead to misinterpretations of behaviors, emotions, and experiences, resulting in incorrect diagnoses that fail to address the underlying issues.

The Impact of Racial Bias

Schizophrenia, bipolar disorder, and post-traumatic stress disorder have historically been over diagnosed among Black and African American patients, reflecting cultural factors that influence clinical decision-making (Morgan, 2014). Numerous studies have shown that when taking a closer look at mental illness among various populations, Black and African American patients receive higher ratings of psychosis than their white counterparts, even after controlling for other factors. These observations suggest that in Black and African American subjects, psychotic symptoms may be overvalued by clinicians, skewing diagnoses toward schizophrenia-spectrum conditions despite similar symptoms among white subjects (Morgan, 2014). Misdiagnosis of schizophrenia and bipolar disorder can have especially harmful consequences because these conditions may require high doses of psychotropic medication for treatment.

Additionally, Black teenagers are 50 percent more likely than their white peers to show signs of bulimia but get diagnosed significantly less, even if they have identical symptoms (Oladipo, 2019). Further, BIPOC and other marginalized individuals are less likely to be asked by a doctor about eating disorder symptoms and less likely to be diagnosed or given treatment for eating disorders, which we explored in last week’s blog post. These statistics shed light on racial biases that exist within mental healthcare clinicians. 

Consequences of Misdiagnosis

The misdiagnosis of mental illnesses due to racial bias has profound consequences. One of the primary concerns is the exacerbation of existing health disparities. Misdiagnosed individuals may receive inappropriate treatments or interventions, leading to worsened symptoms, prolonged suffering, and an increased burden on both the individual and their community. The lack of accurate diagnoses also perpetuates the stereotype that mental illnesses are less prevalent or severe within certain racial or ethnic groups.

The Importance of Cultural Awareness

Culture plays an integral role in shaping an individual's experiences, expressions, and responses to mental health challenges. Failure to consider cultural context when diagnosing mental illnesses can result in misunderstandings. Symptoms perceived as abnormal or distressing within one cultural framework might be entirely typical within another, underscoring the importance of cultural awareness training for mental health professionals to ensure accurate assessments.

Unraveling the Root Cause

The roots of racial bias within mental health diagnoses are deeply entwined with broader societal issues. Socioeconomic disparities and limited access to quality healthcare are factors that contribute to misdiagnosis and lack of proper treatment. One study reported that African American and Latino patients were less likely than White patients to receive guideline-adherent treatment for anxiety disorders and depression (Young et al., 2001). Another study found that African Americans were relatively unlikely to receive guideline-based care (Wang et al., 2000). Lack of diversity in the mental health workforce also perpetuates bias, as professionals may not be equipped to understand the unique challenges faced by patients from different racial backgrounds.

Charting the Path Forward

Addressing the connection between racial bias and misdiagnosis requires a multifaceted approach. Mental health institutions and professionals must commit to ongoing education and training that emphasizes cultural competence and sensitivity. Diversifying the mental health workforce is paramount, as representation fosters understanding and facilitates trust between patients and practitioners. Additionally, integrating cultural considerations into diagnostic processes can bridge the gap between different perspectives on mental health. This involves engaging with patients collaboratively, valuing their insights and experiences, and tailoring treatment plans that acknowledge their cultural identities.

As we strive for equitable mental healthcare, confronting the intersection of racial bias and the misdiagnosis of mental illnesses is a crucial step. By dismantling the barriers created by bias and striving for cultural competence, mental health professionals can make substantial strides in preventing misdiagnosis and providing effective, individualized care. It is time to transform the mental health landscape into one that embraces diversity, recognizes the impact of bias, and ultimately fosters healing and well-being for all.

Sources

• Moran, M. (2014). Overdiagnosis of Schizophrenia Said to Be Persistent Among Black Patients. Psychiatric News. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2015.1a17

• Oladipo, G. (2019). Black People Like Me Are Being Failed by the Mental Health System. Here’s How. Healthline. https://www.healthline.com/health/racism-mental-health-diagnoses

• Snowden, L. (2023). Bias in Mental Health Assessment and Intervention: Theory and Evidence. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447723/

• Wang, P. S, Berglund, P., & Kessler, R.C. (2000). Recent care of common mental disorders in the United States; prevalence and conformance with evidence-based recommendations. J Gen Intern Med. 15(5):284-92. 10.1046/j.1525-1497.2000.9908044.x. PMID: 10840263; PMCID: PMC1495452.

• Young, A. S., Klap, R., Sherbourne, C. D., & Wells K.B. (2001). The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 58(1):55-61. 10.1001/archpsyc.58.1.55. PMID: 11146758.